A bulging disc is a very common injury of the spine that can occur anywhere in the vertebral column, but most commonly in the lower back. It is sometimes referred to by health professionals as a slipped disc or disc herniation. A bulging disc can occur suddenly and may also come on over time, and sometimes people have no pain or problems at all with a bulging disc. However, it can also cause severe pain and disability in patients. People suffering from a lumbar bulging disc will have the most trouble with bending and picking things up. Movements like twisting can also be uncomfortable. People with bulging discs can often relieve some of their pain by lying down with their feet up and resting from activity.
The disc is a specialised shock absorber that sits between the vertebrae of the spine, absorbing shock and providing stability. The nucleus pulposus is the shock absorber part in the center of the disc which is made of different material. In order to absorb shock, it has to squeeze and expand, in rare cases it can be damaged or “break”. In the time between the damage and it healing to a normal disc again the intervertebral disc is said to be “bulging”. This damage to the disc can be caused by a pre-existing weakness in the disc, or perhaps high forces being applied to the spine. A good example of a possible cause would be incorrectly lifting a heavy box with poor posture and muscular bracing causing a heavy force to injure the disc.
The bulging disc can be diagnosed in the physio clinic. The physio cannot truly know if the disc is bulging or not, however they can diagnose a “disc dysfunction” and find the cause of this dysfunction and treat accordingly.
Lumbar disc bulges are responsible for acute and crippling lumbar pain. It is very important to perform the correct exercises to relieve this pain.
What Causes a Bulging Disc?
When a bulging disc, disc herniation or disc rupture occurs, it is typically due to either:
- a pre-existing weakness in the annulus, or
- a sudden increase in pressure through the disc causing fibres of the annulus to tear.
The causes of disc injury can be summarised under three headings:
1. Accumulated Microtrauma
Repeated microtrauma over an extended period can lead to disc injury. The best example of accumulated microtrauma is poor posture.
2. Sudden Unexpected Load
Sudden unexpected load to the intervertebral discs can also occur in traumatic situations, ie: a motor vehicle accident. This may happen due to the nature of the sudden forces exerted through your body at the time of impact and your bodies attempt to repel those forces.
Ask your physiotherapist about these principles.
3. Genetic Factors
As with many conditions spinal disc injury is considered to have a genetic predisposition.
How is a Bulging Disc Diagnosed?
Your physiotherapist or doctor will suspect a spinal disc injury based on the history of your injury and your symptom behaviour. Your physiotherapist will perform clinical tests to confirm a spinal disc injury and detect if you have any signs of nerve compression. The most accurate diagnostic tests to confirm the extent of your spinal disc injury are MRI and CT scans.
Bulging Disc Treatment
Most minor and moderately bulging disc injuries are treated conservatively without the need for surgery. In order to allow the torn fibres of the annulus to heal and the disc bulge to resolve fully, your bulging disc treatment is centred on encouraging the fluid to return and remain in the centre of the disc. This keeps the torn fibres closer to one another and the structure of the annulus as normal as possible.
Your physiotherapist will advise you on the best positions to stay in and may tape or brace your spine. They’ll also explain to you the postures to avoid, which can be detrimental to your recovery.
By maintaining the disc fluid in the central position that you intend it to stay, you are helping Mother Nature to lay down its scar tissue optimally for an excellent long-term solution. Please remember that scar tissue formation will take at least six weeks, so the longer that you avoid aggravating postures the better!.